What investigations should be performed to confirm a diagnosis of peptic ulcer disease in primary care?

Investigations to confirm a diagnosis of peptic ulcer disease in primary care include:

• Testing for Helicobacter pylori infection using a carbon-13 urea breath test or stool antigen test, ensuring the patient has not taken proton pump inhibitors (PPIs) in the past 2 weeks or antibiotics in the past 4 weeks to avoid false negatives.
• If breath or stool antigen tests are unavailable, locally validated laboratory serological testing may be used, but serology is generally less reliable and not routinely recommended.
• Assessment for alarm symptoms that may suggest complications or other serious pathology, which may necessitate urgent referral rather than primary care diagnosis.

Endoscopy is not routinely performed in primary care but is indicated if alarm symptoms are present or if symptoms are refractory to initial management.